Integrated PBL scenario

Question 1

What is menopause?

Answer 1

• Menopause is the time that marks the end of menstrual cycles
• Diagnosed after 12 months without a menstrual period
• Occurs between 45-55 years

Question 2

4 stages of menopause

Answer 2

Premenopause
- normal reproductive stage 
- peak fertility at 25
Peri menopause 
- irregular menstrual cycle 
- hot flushes 
- weight gain 
Menopause
- ovaries stop releasing eggs
- permanent cessation of menstruation 
- vaginal discomfort 
Post menopausal 
- oestrogen levels continue to decline
- UTIs 
- osteoporosis

Question 3

Hormonal changes in menopause

Answer 3

• Ovarian follicular activity fails as responsive oocytes decrease
• Reduction in oestrogen and progesterone, no corpus leuteum to maintain
• Low oestrogen causes disruption to cycle
• Failure in negative feedback loop causes rise in luteinising hormone and follicle stimulating hormone

Question 4

The decrease in which what hormones cause menopause symptoms?

Answer 4

• progesterone levels drop in proportion to oestrogen leading to effects of unopposed oestrogen
• progesterone falls more than oestrogen
• widening gap between two hormones

Question 5

Treatment and management of menopausal symptoms

Answer 5

Non-hormonal treatments
- tibolone and raloxifene (if post menopausal) selective oestrogen receptor modulators
- bisphosphonates decrease osteoclast activity
- clonidine (alpha-2 agonist) and venlafaxine (antidepressant)
HRT
- oestrogen and progesterone (uterus present)
- oestrogen only (uterus absent)

Question 6

Why does menopause cause osteoporosis?

Answer 6

• Oestrogen modulates bone remodelling
• In gut causes increased Ca2+ absorption
• In bone causes decreased reabsorption and inhibits osteoclasts
• Decrease in oestrogen in menopause causes loss of bone mass